Number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation is associated with complication rate

Abstract

Introduction: Surgical treatment of distal humerus fractures can lead to numerous complications. Data suggest that the number of screws in the distal (articular) segment may be associated with complication rate. The purpose of this study is to evaluate the association between a number of screws in the distal segment and complication rate for surgical treatment of distal humerus fractures. We hypothesize that the number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation (ORIF) will be inversely proportional to the complication rate. Methods: We performed a single-center retrospective cohort study of 27 patients who underwent ORIF of distal humerus fractures C-type with at least six months of radiographic and clinical follow-up. Clinical outcomes including a range of motion, pain, revision surgery for stiffness and/or heterotopic ossification (HO), nonunion, and persistent ulnar nerve symptoms requiring revision neurolysis were recorded. Results: In C-type fractures, the use of three or fewer articular screws was significantly associated with nonunion or loss of fixation (RR 17, p = 0.006). Nineteen of 36 (53%) patients experienced at least one complication. The surgical approach, plate configuration, age, and ulnar nerve treatment (none, in situ release, transposition) were not associated with the need for revision surgery. Men had a higher risk of requiring surgical contracture release due to improving post-operative stiffness (RR 12, p = 0.02). Conclusion: In this retrospective study, the use of three or fewer screws to fix articular fragments in AO type C fractures was a significant risk for nonunion or loss of fixation. Plate configuration and surgical approach did not correlate with outcomes. Men had higher rates of complications and required more frequent revision surgery compared to women.

Distal Humerus Fracture Malunion in Adults: A Case Report and a Review of the Literature

“…Stable fixation is of paramount importance for early mobilization [5,10,13]. The intraarticular level of the fracture should be fixed with as many screws as possible (at least three), which need to be inserted through the plate [3,14]. Although plate configuration seems to be more stable in biomechanical studies, than 90/90 fixation, this is not interpreted in vivo [9].…”

Low and high body mass index and lower numbers of screws in the articular segment are risk factors for non-union of distal humeral fractures in the elderly: A multi-center retrospective study (TRON study)

“…He suggested that at least four long screws should be used to completely penetrate the distal end fragment from one side to the other. Grogan et al 8 showed that the use of ≤3 screws in distal humeral fractures was a significant risk factor for non-union. A biomechanical study revealed that the total number of screws was the most influential variable.…”

“…6 Another study reported that long oblique fracture patterns and obesity are prognostic factors for non-union. 7 Recent studies reported that the use of ≤3 screws for the fixation of the articular fragment in AO type C fractures, 8 and ORIF with tension band wiring 9 are significant risks for non-union. These studies included relatively small study populations, did not include comparison by fixation method and were conducted in single-center settings.…”

Combined Medial and Lateral Approach Versus Paratricipital Approach in Open Reduction and Internal Fixation for Type C Distal Humerus Fracture: A Randomized Controlled Study

“…The reduction of the articular fragments was checked under direct visualization or fluoroscopy guidance. Two vertical double plates (Trauson Jiangsu Medical Equipment Company, China) were used to definitively fix from lateral to medial side, with at least four screws in the articular fragments 19 . Fracture fixation stability and elbow range of motion were assessed.…”

“…Two vertical double plates (Trauson Jiangsu Medical Equipment Company, China) were used to definitively fix from lateral to medial side, with at least four screws in the articular fragments. 19 Fracture fixation stability and elbow range of motion were assessed. Lateral collateral ligamentous complex should be repaired with drill‐holes and a locking suture technique to prevent posterolateral rotatory instability in all cases.…”